Chronic Pancreatitis

Question 1

List the common causes of pancreatitis

Answer 1

I: idiopathic
G: gallstones
E: ethanol (alcohol)
T: trauma
S: steroids 
M: mumps (and other infections) / malignancy
A: autoimmune
S: scorpion stings/spider bites
H: hyperlipidaemia/hypercalcaemia/hyperparathyroidism (metabolic disorders)
E: ERCP
D: drugs

Question 2

What is the diagnostic criteria for acute pancreatitis?

Answer 2

2 out of 3 of the following criteria must be met:
o Epigastric pain associated with nausea and vomiting and radiating to the back
o Serum lipase or amylase greater than 3x the normal range
o Confirmation on imaging: either abdominal US or CT showing pancreatic inflammation (peri-pancreatic fluid and fat stranding)

Question 3

What investigations would you do to look for complications of pancreatitis?

Answer 3

ECG: arrhythmias due to electrolyte disturbances
BSL: hyperglycaemia due to decreased insulin

FBC: normocytic anaemia (hypovolaemia)
EUC: electrolyte disturbances, inc urea/creatinine
CMP: hypocalcaemia (saponification)

Question 4

How does pancreatitis lead to loose stools and weight loss?

Answer 4

Inflammation and decreased effective exocrine pancreatic function:

• Decreased lipase, amylase, protease
• Food not adequate broken down intraluminally to be absorbed
• Malabsorption > weight loss
• Fatty stools as fat not broken down
• Large carbohydrates in gut cause osmotic diarrhoea

Weight loss can also be due to food avoidance due to post-prandial pain

Question 5

Pathophysiology of acute pancreatitis?

Answer 5

• Different causes but same pathway of damage
• Premature activation of proteolytic enzymes while still in the pancreas rather than in duodenum
• Causes overcome normal pancreas defences
• Activated enzymes rupture more vacuoles containing proenzymes
• Phospholipase + lipase > fat necrosis
• Elastase > endothelial damage + haemorrhage